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General NPI Number Information
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NPI Number | 1043218555
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Entity Type | Individual
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Provider Name | TODD REYBURN MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 2008 W BOULEVARD
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City | KOKOMO
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State | IN
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Zip | 46902-6079
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Country | US
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Telephone | 765-454-9729
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1644
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-1644
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Country | US
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Telephone | 866-494-8258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01048555A
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License Number State | IN
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